BG rise at end of Lantus

Hi

I've been T1 now for 23 years, and still realising I still have so much to learn from other diabetics' experiences, so I'm hoping one of you will be able to offer me some advise with this. It has me stumped!
I take my lantus on a night before bed, and find that from about tea time my BG is starting to rise. I think my lunch QA is about right as at about the four hour mark my BG is fine, but then as I generally have my tea about 6 hours after lunch my pre-tea BG is normally up to about 12...My tea ratio is 2:1 and I always go to bed on about a 11 or 12, but then it's down to about 5 on a morning. I don't feel inclined to increase the BI due to the low reading pre-breakfast, but clearly need something extra to help me through the last few hours of the BI.

I've tried Levemir in the past, but had problems with red and itchy injetions sites so went back to Lantus (I have to say though, it didn't make a massive difference to overall control for me).

I'm on lantus and was injecting once per night before bed like you with high BG before evening meals. The Dafne educators suspected that the lantus was running out by the afternoon therefore the BG rise before tea. They split my dose to twice per day : morning and night. It worked for me as my BGLs b4 tea are now between 5 & 7. Best to go see your HCP for advice re this if you want to give it a go because it took me a while to get the dose right plus I had to adjust the QA as well . Once again, seek advice first because the splitting of lantus must be done under medical supervision.

Good luck with your query.

I had a similar situation before completing the DAFNE course, and it was suggested to me to split my Lantus dose into two.
After the DAFNE course I went back to one dose of Lantus, but changed the time to when I have an evening meal, though at times it seems that the Lantus occasionally seems to run out before the evening injection.

If you decide to change the time of the Lantus injection don't change it in one go, change the time gradually (1 Hour a day). When it was suggested to me to split the dose I was advised to divide it in two and have the two injections 12 Hours apart (i.e.11:00AM and 11:00PM) though it is difficult to remember to do the injection mid morning depending on what time you normally do the injection before bed.

I would agree with the rest, split the Lantus, I am on Levemir but I find easty times to remember is breakfast and dinner (6:00am and 5:30pm)........that might not suit you but as long as you get coverage for the whole day.......

Thanks so much for your replies, they are very much appreciated. I actually split it not long after I did Dafne about 3 years ago and didn't notice a great deal of improvement, although I think it's probably safe to say that my overall levels then were under less control than now. Maybe I'll be able to identify more of an improvement if I were to try it now. Funnily enough, once my consultant was aware that I had split it he was quite horrified and suggested that having 2 sets of BI and QA all working at the same time made identifying problems much harder - think he probably had a point in that respect. Then again, he'd not been on the dafne training....!
Thanks again

Hi, I think it is a case of Lantus running out, but like others I'm not a HCP so its just personal opinion. Given the scenario you originally described your QA should have stopped working ( 6 hours after lunch, it generally should only last 4-5 hours) and you then need your BI to keep your levels steady. If it has also reduced in effectiveness ( it should 'tail' off gradually between 12 and 24 hours according to its profile) your BG will start to rise. The only sure way is to take your BI and not eat anything all day, if your BI is right then your BG should stay at similiar levels. This is not an easy thing to do I know but that is the theory anyway. Although slighting your BI dose does mean you have two lots of BI acting at the same time, they should again in theory be reducing and increasing in tandem and so not be acting totally at the same time.
I think most of us do find a split dose better, but as ever we are all different. If your control is quite good now it may be you can see more effect if you split your dose. It may be worth a try however it doesn't sound like your consultant would support it, so you really need a DAFNE educator to support you otherwsise its going to be hard to do on yuor own.

Sorry not to have replied to this before but I am sure that your Lantus is running out. For most people it is not a true 24h insulin and in my view most people should use it as Levemir and take it twice daily, probably bedtime and before breakfast. Probably lasts about 18h in most cases, its just that it has been marketed as a once a day insulin by the company that make it so most HCPs believe this.

Speaking as another who had to work out that they needed to split Lantus, if you cannot manage a carb free day, I found adjusting my lunchtime ratio was another way of determing if it was running out. I found that I hypo'd before it ran out which meant that the background was letting me down after around 2pm. Lantus, when I was still on it, worked for 16 hours and I had the split dose over lap in the morning (apparently I need more insulin over that period). I changed to Levemir because I was not getting on well with Lantus as a split dose.